Pharmaceutical cyclosporin compositions

ABSTRACT

An oral cyclosporin composition comprises minicapsules having a core containing a cyclosporin, especially cyclosporin A in a solubilised liquid form. The minicapsules have a release profile to release the pre-solubilised cyclosporin, at least in the colon. The composition may be used for treating a range of intestinal diseases.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. application Ser. No.15/051,356, filed on Feb. 23, 2016, which is a divisional of U.S.application Ser. No. 13/942,492, filed Jul. 15, 2013, now U.S. Pat. No.9,387,179, which is a divisional of U.S. application Ser. No.12/594,534, which was filed on Feb. 22, 2010, now U.S. Pat. No.8,535,713, which is the U.S. National Stage of International ApplicationNo. PCT/IE2008/000038, filed Apr. 4, 2008, which was published inEnglish under PCT Article 21(2), which in turn claims the benefit ofU.S. Provisional Application No. 60/907,490, filed Apr. 4, 2007, andU.S. Provisional Application No. 61/006,498, filed Jan. 16, 2008. Theapplications are incorporated herein in their entirety.

The present invention relates to pharmaceutical cyclosporincompositions.

INTRODUCTION

Cyclosporins form a class of polypeptides commonly possessingimmunosuppressive and anti-inflammatory activity. The most commonlyknown cyclosporin is cyclosporin-A. Other forms of cyclosporins includecyclosporin-B, -C, -D, and -G and their derivatives. It should beunderstood that herein the terms “cyclosporin” or “cyclosporins” refersas used herein to any of the several cyclosporins derivatives orprodrugs thereof, or to any mixture of any of the above.

Cyclosporin A is a hydrophobic material exhibiting poor bioavailability.To improve the aqueous solubility of the hydrophobic cyclosporin A, thecurrent marketed liquid oral formulations are emulsified using a mixtureof oils, ethanol, a triglyceride and a surfactant (U.S. Pat. No.4,388,307). While overcoming the solubility problem, these formulationshave a variety of difficulties, such as unpleasant taste, which isunacceptable for long-term therapy. Therefore, the use of soft gelatincapsule dosage forms masks the taste of the solution as well asunitising the dose.

The bioavailability of these liquid formulations or the soft gelatincapsule formulation containing ethanol, oils and Labrafil surfactant, islow and variable, and reported to be about 30%. U.S. Pat. No. 5,342,625claim an improved formulation of cyclosporin in the form of amicroemulsion pre-concentrate. In addition to the cyclosporin, thisformulation requires a hydrophilic phase, a lipophilic phase, and asurfactant. The microemulsion pre-concentrate is claimed to provideenhanced bioavailability. As cyclosporin has a narrow therapeutic indexand a short half-life, to provide adequate 24 hour protection it must beadministered twice daily.

Cyclosporin A, available in soft gelatin capsule or oral suspensionform, is indicated for the prevention of organ rejection in kidney,liver and heart transplants, for the treatment of severe activerheumatoid arthritis (RA) and severe recalcitrant plaque psoriasis.Other potential indications include Bechet's disease, anemia, nephroticsyndrome and Graft Versus Host Disease (GVHD), includingGastro-Intestinal Graft Versus Host Disease (GI-GVHD). Furthermore, arange or other diseases may benefit from treatment with cyclosporin A(Landford et al. (1998) Ann Intern Med; 128: 1021-1028).

Based on the poor and intra-subject bioavailability variability and theneed for twice-daily administration, significant dose-relatednephrotoxicity and hepatotoxicity are side effect associated with longterm use of cyclosporin A. When administered intravenously cyclosporin Ais known to be effective in the treatment of refractory ulcerativecolitis (D'Haens et al., Gastroenterology 2001; 120:1323-1329). In astudy by Sandborn et al. (J Clin Pharmacol, 1991; 31:76-80) the relativesystemic absorption of cyclosporin following oral and intravenous aswell as oil- and a water-based enemas was determined. Based onnegligible plasma cyclosporin concentrations following enemaadministration, it was suggested that cyclosporin, even whensolubilised, is poorly absorbed from the colon. The enemas howeverdemonstrated considerable efficacy in the treatment of inflammatorybowel disease (Ranzi T, et al, Lancet 1989; 2:97). Orally administeredcyclosporin demonstrated very limited efficacy in the treatment ofinflammatory bowel disease.

STATEMENTS OF INVENTION

According to the invention there is provided an oral cyclosporincomposition comprising minicapsules having a core containing acyclosporin in a solubilised liquid form, the minicapsules have arelease profile to release the pre-solubilised cyclosporin at least inthe colon.

In one embodiment the minicapsules have a release profile to alsorelease pre-solubilised cyclosporin in the Ileum.

The minicapsules may have a release profile to also releasepre-solubilised cyclosporin in the small intestine.

In one embodiment the cyclosporin is cyclosporin A. The cyclosporin Amay be present in the core in an amount of from 2.5 to 25% w/w,preferably in an amount of from 2.5 to 10% w/w.

In one embodiment when exposed to a use environment less than 20% of thecyclosporin A is released within 4 hours, preferably when exposed to ause environment less than 10% of the cyclosporin A is released within 4hours.

In one embodiment when exposed to a use environment less than 50% of thecyclosporin A is released within 12 hours, preferably when exposed to ause environment less than 35% of the cyclosporin A is released within 12hours.

When exposed to a use environment preferably less than or equal to 100%of the cyclosporin A is released within 24 hours.

In one embodiment when exposed to a use environment less than 10% of thecyclosporin A is released within 4 hours, less than 35% of thecyclosporin A is released within 12 hours, and substantially all of theremaining cyclosporin A is released between 12 and 24 hours.

In another embodiment when exposed to a use environment less than 20% ofthe cyclosporin A is released within 4 hours, less than 50% of thecyclosporin A is released within 12 hours, and substantially all of theremaining cyclosporin A is released between 12 and 24 hours.

In a further embodiment when exposed to a use environment less than 10%of the Cyclosporin A is released within 6 hours, less than 30% of thecyclosporin A is released within 12 hours, less than 70% of thecyclosporin A is released within 18 hours and up to 100% of thecyclosporin A is released at 24 hours.

The minicapsules preferably comprise a solid shell containing thesolubilised cyclosporin A. Usually the minicapsules are modified toprovide the release profile.

In one case a modified release coating is applied to the outer shell ofthe minicapsules. Preferably a polymeric material is used to achievemodified release.

The polymeric material may be methacrylate and/or ethylcellulose.

In one embodiment the coating includes a dissolution enhancing agent.Preferably the dissolution enhancing agent is degraded by bacterianormally present in the lower gastrointestinal tract. The dissolutionenhancing agent may be selected from one or more of pectin, amylose andalginate or derivatives thereof. In one case the dissolution enhancingagent is present in an amount of from 0.5 to 2% w/w of ethylcellulose.

In one embodiment the core comprises cyclosporin A, a solubilisationagent, a co-emulsifier, a surfactant, a permeability enhancer and acarrier. In one case the solubilisation agent comprises ethanol. Thesolubilisation agent may comprise triglycerides. The co-emulsifyingagent may comprise fatty acid ester complexes. The surfactant agent maycomprise fatty acid ester complexes. The permeability enhancing agentmay comprise fatty acid ester complexes. In one case the carriercomprises a hydrophobic liquid, such as an oil, for example olive oil.

In one embodiment an outer shell layer of the minicapsules is modifiedto achieve modified release. In one case the liquid core of theminicapsules is modified to achieve modified release. Polymericmaterials may be used to achieve modified release.

The cyclosporin is preferably released along the gastrointestinal tractin a form that maximises pre-systemic mucosal absorption. Thecyclosporin may be released along the gastrointestinal tract in a formthat maximises local gastrointestinal activity. The cyclosporin may bereleased along the gastrointestinal tract in a form that maximisesgastrointestinal lumen activity. The cyclosporin may be released alongthe gastrointestinal tract in a form that maximises chronotherapy.

In one embodiment wherein the formulation contains an adhesive entitysuch as a muco- or bio-adhesive.

In one embodiment the composition comprises a hard gelatine capsule, asprinkle, or a tablet containing the minicapsules.

In one case the minicapsules further comprise excipients to maximisesolubility of the cyclosporin. The composition may further compriseexcipients to maximise permeability of the cyclosporin at least alongthe gastrointestinal lining or mucosal lining. The composition may alsocomprise excipients to enhance the therapeutic potential of thecyclosporin in the ileum and colon. The excipients may be selected fromone or more of absorption limiters, absorption enhancers, surfactants,co-surfactants, co-solvents, essential oils such as omega 3 oils,natural plant extracts such as neem, ion-exchange resins, anti-oxidants,polyethers, stabilizers, preservatives, bacteria degradable conjugationlinkers such as azo bonds, polysaccharides such as amylose, guar gum,pectin, chitosan, inulin and cyclodextrins.

Preferably the composition facilitates mucosal absorption over 24 hours.

The composition may be used in treating or preventing inflammatory boweldisease; in treating ulcerative colitis; in treating Crohn's disease;for the treatment or prevention of graft-versus-host disease such asgastro-intestinal graft-versus-host disease; and/or in treating orpreventing irritable bowel syndrome.

The composition may be presented for administration in paediatricformats.

The invention also provides a composition of the invention combined withanother active pharmaceutical in a single oral dosage form.

BRIEF DESCRIPTION OF THE DRAWINGS

The invention will be more clearly understood from the followingdescription of some embodiments thereof, given by way of example only,with reference to the accompanying drawings, in which:

FIG. 1 is a graph showing the dissolution rate of Cyclosporin A fromminicapsules coated with 12.8% and 22.5% weight gain Surlease™;

FIG. 2 is a bar chart showing the colon length of DSS-induced colitismice treated with Capsule A (0.25 mg CyA/day; immediate release),Capsule B (0.25 mg CyA/day; ileum release) and Capsule C (0.25 mgCyA/day; colon release) for 7 days, with 6 mice in each group;

FIG. 3 is a graph showing the average weight of DSS-induced colitis micetreated with Capsule A (0.25 mg CyA/day; immediate release), Capsule B(0.25 mg CyA/day; ileum release) and Capsule C (0.25 mg CyA/day; colonrelease);

FIG. 4 is a graph showing the Disease Activity Index (DAI) ofDSS-induced colitis mice treated with Capsule A (0.25 mg CyA/day;immediate release), Capsule B (0.25 mg CyA/day; ileum release) andCapsule C (0.25 mg CyA/day; colon release) for 7 days, with 6 mice ineach group;

FIG. 5 is a graph showing the dissolution rate of Cyclosporin A fromuncoated minicapsules (uncoated), minicapsules coated with 22% weightgain Eudragit™ RS (076/2007) and minicapsules coated with 22% weightgain Eudragit™ RS plus 14% weight gain Eudragit™ FS30D (077/2007) in0.75% SDS (99);

FIG. 6 is a graph showing the dissolution rate of Cyclosporin A fromuncoated minicapsules (uncoated) and with minicapsules coated with 22%(069/2007) and 37% (072/2007) weight gain Surlease® as well as 22%weight gain Surelease® plus 14% weight gain Eudragit™ FS30D (075/2007)in 0.75% SDS (99);

FIG. 7 is a graph showing the dissolution rate of Cyclosporin A fromminicapsules coated with 20% weight gain Surlease®/1% Pectin (020/2008)and 20% weight gain Surlease®/1% Pectin plus 9% weight gain EudragitFS30D (021/2008) in 0.75% SDS (99);

FIG. 8 is a graph showing the dissolution rate of Cyclosporin A fromminicapsules coated with 20% weight gain Surlease®/1% Pectin plus 11%weight gain Eudragit FS30D following 2 hours in pH 7.4% phosphate buffersolution followed by 22 hours in 0.75% SDS dissolution media;

FIG. 9 is a graph showing the dissolution rate of Cyclosporin A fromminicapsules coated with 13% weight gain Surlease® (013/2008) 13 weightgain Surelase®/1% Sodium Alginate (005/2008) and 13% weight gainSurlease®/0.5% Sodium Alginate (011/2008) in 0.75% SDS;

FIG. 10 is a graph showing the dissolution rate of cyclosporin A fromminicapsules coated with 22% Eudragit RS30D; and

FIG. 11 is a schematic illustration of the minicapsule form used in theformalities of the invention.

DETAILED DESCRIPTION

There is therefore a need for an improved pharmaceutical composition ofcyclosporins. The invention enables the exploitation of the efficiencyof cyclosporin in the treatment of ulcerative colitis. In the inventionthe cyclosporin remains in a soluble form in the colon and the systemicside effects associated with long-term high oral or intravenous doses ofcyclosporin. A colon specific form that releases cyclosporin in asoluble form is provided.

The invention provides a method of preventing or treating aninflammatory or immune disorder, particularly relating to inflammatoryor immune diseases that effect the gastrointestinal tract, in a subjectwhile eliminating or reducing the toxicity associated with theadministration of cyclosporin, through the orally delivered,colon-specific release of a therapeutically effective amount ofcyclosporin in combination with a pharmaceutically acceptable carrier(s)or excipient(s).

The controlled release of active pharmaceutical agents is only trulyuseful if the agent is available to interact with its receptor or siteof action in an active form. Unless the agent is in a fully soluble formit is unlikely to interact with its intended receptor or exert itsdesired action. The invention is a drug delivery format that enables therelease cyclosporin from the format in soluble or readily-soluble form.

The invention provides an oral drug delivery technology that permits thecolon-specific release of pre- or readily-solubilised cyclosporin intandem with a controlled release formulation that permits release andabsorption in the lining of the small intestine, the ileum and/or thecolon to ensure a true once-daily formulation.

This once-daily technology which enables colon delivery of solublecyclosporin is advantageous as an effective drug delivery mechanism forenhanced treatment of diseases of colon, especially inflammatory- orischemic-induced diseases, (ulcerative colitis, Crohn's disease,Gastro-Intestinal Graft Versus Host Disease (GI-GVHD) and otherinfections) whereby high local concentrations of soluble drug can beachieved while minimizing side effects that occur because of release ofdrugs in the upper GIT or unnecessary systemic absorption.

Cyclosporins are well known to have limited colonic absorption.

Additionally, for conditions that may affect the entiregastro-intestinal tract, including the small intestine, such as Crohn'sDisease and GI-GVHD, a sustained release format of pre-solubilisedcyclosporin, exhibiting limited systemic absorption is provided.

The invention enables the availability of cyclosporin in a solubleliquid. In addition to the active cyclosporin, the liquid dosage formsmay contain inert diluents commonly used in the art such as, forexample, water or other solvents, solubilizing agents and emulsifierssuch as ethyl alcohol, isopropyl alcohol, ethyl carbonate, ethylacetate, benzyl alcohol, benzyl benzoate, propylene glycol, 1,3-butyleneglycol, dimethyl formamide, oils (in particular, cottonseed, groundnut,corn, germ, olive, castor, fish, neem and sesame oils), polyethers (inparticular substances like dimethyl isosorbide, dimethyl isoodide anddimethly isomannide and mixtures of glyceryl monoesters of C8-C22 fattyacids and hexaglyceryl to pentadecaglyceryl monoesters of C8-C22 fattyacids in variable ratios from 1:3 to 1:8) glycerol, tetrahydrofurfurylalcohol, polyethylene glycols and fatty acid esters of sorbitan, andmixtures thereof. Besides inert diluents, the oral compositions can alsoinclude adjuvants such as wetting agents, emulsifying and suspendingagents, sweetening, flavoring, and/or perfuming agents.

The invention enables successful colonic delivery. In the inventioncyclosporin is protected from absorption in the environment of the uppergastrointestinal tract (GIT) but allows abrupt and/or sustained releaseinto the proximal colon, which is the optimum site for colon-targeteddelivery of cyclosporin. Such colon targeting is particularly of valuefor the treatment of diseases of colon such as Crohn's diseases,ulcerative colitis, and GVHD, including GI-GVHD.

The invention allows for a broad range of controlled release polymercoatings to be applied. Coating materials may include any combination ofthe commercially available acrylic-, methacrylic-, ethylcellulose-basedpolymers (such as, but not limited to the Eudragit™ and Surelease®range), as well as other polymers with natural polysaccharides,including, but not limited to amylose, pectin, alginate, amylopectin,chitosan, galactomannan, guar gum and any derivatives thereof, has thepotential to customise how, where and when drugs are released from theunderlying or embedded solid, semi-solid or liquid forms. In allexamples cited in this specification, any specific polymer may beinterchanged or combined with any other polymer to enable the requiredrelease profile according to the preferred optimal therapeutic outcomeenvisaged.

The invention provides a solid oral dosage form comprising the multipleminicapsule modified release composition of the present invention, thesaid minicapsules being one layer or multiple layer. Where a two layerminicapsule has a shell comprised of a gelling agent with a controlledrelease polymer or other coating or comprised of controlled releasepolymer or other materials.

In various embodiments comprising a membrane-controlled dosage form, thepolymeric material comprises methacrylic acid co-polymers, ammoniomethacrylate co-polymers, or mixtures thereof. Methacrylic acidco-polymers such as EUDRAGIT™ S and EUDRAGIT™ L (Evonik) are suitablefor use in the controlled release formulations of the present invention.These polymers are gastroresistant and enterosoluble polymers. Theirpolymer films are insoluble in pure water and diluted acids. Theydissolve at higher pHs, depending on their content of carboxylic acid.EUDRAGIT™ S and EUDRAGIT™ L can be used as single components in thepolymer coating or in combination in any ratio. By using a combinationof the polymers, the polymeric material can exhibit solubility at a pHbetween the pHs at which EUDRAGIT™ L and EUDRAGIT™ S are separatelysoluble.

The membrane coating can comprise a polymeric material comprising amajor proportion (i.e., greater than 50% of the total polymeric content)of at least one pharmaceutically acceptable water-soluble polymers, andoptionally a minor proportion (i.e., less than 50% of the totalpolymeric content) of at least one pharmaceutically acceptable waterinsoluble polymers. Alternatively, the membrane coating can comprise apolymeric material comprising a major proportion (i.e., greater than 50%of the total polymeric content) of at least one pharmaceuticallyacceptable water insoluble polymers, and optionally a minor proportion(i.e., less than 50% of the total polymeric content) of at least onepharmaceutically acceptable water-soluble polymer.

Ammonio methacrylate co-polymers such as EUDRAGIT™ RS and EUDRAGIT™ RL(Evonik) are suitable for use in the modified release formulations ofthe present invention. These polymers are insoluble in pure water,dilute acids, buffer solutions, or digestive fluids over the entirephysiological pH range. The polymers swell in water and digestive fluidsindependently of pH. In the swollen state, they are then permeable towater and dissolved active agents. The permeability of the polymersdepends on the ratio of ethylacrylate (EA), methyl methacrylate (MMA),and trimethylammonioethyl methacrylate chloride (TAMCl) groups in thepolymer. Those polymers having EA:MMA:TAMCl ratios of 1:2:0.2 (EUDRAGIT™RL) are more permeable than those with ratios of 1:2:0.1 (EUDRAGIT™ RS).Polymers of EUDRAGIT™ RL are insoluble polymers of high permeability.Polymers of EUDRAGIT™ RS are insoluble films of low permeability.

The amino methacrylate co-polymers can be combined in any desired ratio,and the ratio can be modified to modify the rate of drug release. Forexample, a ratio of EUDRAGIT™ RS:EUDRAGIT™ RL of 90:10 can be used.Alternatively, the ratio of EUDRAGIT™ RS:EUDRAGIT™ RL can be about 100:0to about 80:20, or about 100:0 to about 90:10, or any ratio in between.In such formulations, the less permeable polymer EUDRAGIT™ RS wouldgenerally comprise the majority of the polymeric material with the moresoluble RL, when it dissolves, permitting creating gaps through whichsolutes can enter the core and dissolved pharmaceutical actives escapein a controlled manner.

The amino methacrylate co-polymers can be combined with the methacrylicacid co-polymers within the polymeric material in order to achieve thedesired delay in the release of the drug. Ratios of ammonio methacrylateco-polymer (e.g., EUDRAGIT™ RS) to methacrylic acid co-polymer in therange of about 99:1 to about 20:80 can be used. The two types ofpolymers can also be combined into the same polymeric material, orprovided as separate coats that are applied to the core.

Eudragit™ FS 30 D is an anionic aqueous-based acrylic polymericdispersion consisting of methacrylic acid, methyl acrylate, and methylmethacrylate and is pH sensitive. This polymer contains fewer carboxylgroups and thus dissolves at a higher pH (>6.5). The advantage of such asystem is that it can be easily manufactured on a large scale in areasonable processing time using conventional powder layering andfluidized bed coating techniques. In a study by Gupta et al (Int JPharm, 213: 83-91, 2001) Eudragit FS 30 D demonstrated its potential forcolonic delivery by resisting drug release up to pH 6.5 and thecombination of Eudragit™ RL and RS proved successful for the sustaineddelivery of 5-ASA at the pH of the colon. Thus, Eudragit™ FS 30 D aloneor with other controlled release polymers holds great potential toenable delivery of minicapsule formulations specifically to the colon.

In addition to the EUDRAGIT™ polymers described above, a number of othersuch copolymers can be used to control drug release. These includemethacrylate ester co-polymers such as the EUDRAGIT™ NE and EUDRAGIT™ NMranges. Further information on the EUDRAGIT™ polymers can be found in“Chemistry and Application Properties of Polymethacrylate CoatingSystems,” in Aqueous Polymeric Coatings for Pharmaceutical Dosage Forms,ed. James McGinity, Marcel Dekker Inc., New York, pg 109-114.

Several derivatives of hydroxypropyl methylcellulose (HPMC) also exhibitpH dependent solubility. Shin-Etsu Chemical Co., Ltd. esterified HPMCwith phthalic anhydride to produce hydroxypropyl methylcellulosephthalate (HPMCP), which rapidly dissolves in the upper intestinaltract. Due to the limited compatibility of HPMCP with several types ofplasticizers, hydroxypropyl methylcellulose acetate succinate (HPMCAS)was developed. The presence of ionizable carboxyl groups in the HPMCASstructure cause the polymer to solubilize at high pH (>5.5 for the LFgrade and >6.8 for the HF grade). This polymer exhibits goodcompatibility with a variety of plasticizing agents and is commerciallyavailable from Shin-Etsu Chemical Co. Ltd. under the proprietary nameAQOAT® in a powdered form to be redispersed in water.

Surelease® dispersion is a unique combination of film-forming polymer;plasticizer and stabilizers. Designed for sustained release and tastemasking applications, Surelease is an easy-to-use, totally aqueouscoating system using ethylcellulose as the release rate controllingpolymer. The dispersion provides the flexibility to adjust drug releaserates with reproducible profiles that are relatively insensitive to pH.The principal means of drug release is by diffusion through theSurelease dispersion membrane and is directly controlled by filmthickness. Increasing or decreasing the quantity of Surelease® appliedcan easily modify the rate of release. With Surelease dispersion,reproducible drug release profiles are consistent right through fromdevelopment to scale-up and production processes.

In addition to the EUDRAGIT™ and Surelease® polymers discussed above,other enteric, or pH-dependent, polymers can be used. Such polymers caninclude phthalate, butyrate, succinate, and/or mellitate groups. Suchpolymers include, but are not limited to, cellulose acetate phthalate,cellulose acetate succinate, cellulose hydrogen phthalate, celluloseacetate trimellitate, hydroxypropyl-methylcellulose phthalate,hydroxypropylmethylcellulose acetate succinate, starch acetatephthalate, amylose acetate phthalate, polyvinyl acetate phthalate, andpolyvinyl butyrate phthalate. Additionally, where compatible, anycombination of polymer may be blended to provide additional controlled-or targeted-release profiles.

The coating membrane can further comprise at least one soluble excipientto increase the permeability of the polymeric material. Suitably, the atleast one soluble excipient is selected from among a soluble polymer, asurfactant, an alkali metal salt, an organic acid, a sugar, and a sugaralcohol. Such soluble excipients include, but are not limited to,polyvinyl pyrrolidone, polyethylene glycol, sodium chloride, surfactantssuch as sodium lauryl sulfate and polysorbates, organic acids such asacetic acid, adipic acid, citric acid, fumaric acid, glutaric acid,malic acid, succinic acid, and tartaric acid, sugars such as dextrose,fructose, glucose, lactose, and sucrose, sugar alcohols such aslactitol, maltitol, mannitol, sorbitol, and xylitol, xanthan gum,dextrins, and maltodextrins. In some embodiments, polyvinyl pyrrolidone,mannitol, and/or polyethylene glycol can be used as soluble excipients.The at least one soluble excipient can be used in an amount ranging fromabout 1% to about 10% by weight, based on the total dry weight of thepolymer. The coating process can be carried out by any suitable means,for example, by using a perforated pan system such as the GLATT,ACCELACOTA, Vector, Diosna, O'Hara, HICOATER or other such coatingprocess equipment

The modifications in the rates of release, such as to create a delay orextension in release, can be achieved in any number of ways. Mechanismscan be dependent or independent of local pH in the intestine, and canalso rely on local enzymatic activity to achieve the desired effect.Examples of modified-release formulations are known in the art and aredescribed, for example, in U.S. Pat. Nos. 3,845,770; 3,916,899;3,536,809; 3,598,123; 4,008,719; 5,674,533; 5,059,595; 5,591,767;5,120,548; 5,073,543; 5,639,476; 5,354,556; and 5,733,566.

With membrane-modified extended-release dosage forms, a semi-permeablemembrane can surround the formulation containing the active substance ofinterest. Semi-permeable membranes include those that are permeable to agreater or lesser extent to both water and solute. This membrane caninclude water-insoluble and/or water-soluble polymers, and can exhibitpH-dependent and/or pH-independent solubility characteristics. Polymersof these types are described in detail below. Generally, thecharacteristics of the polymeric membrane, which may be determined by,e.g., the composition of the membrane, will determine the nature ofrelease from the dosage form.

In particular, the present invention provides for formulations ofminicapsules or minispheres wherein the modified release is dependentupon, where appropriate, any one of the core formulation constituents,the shell composition or the shell coating. The minicapsules orminispheres may be produced through the utilisation of surface tensionof one or more different solutions which when ejected through an orificeor nozzle with a certain diameter and subject to specific frequenciesand gravitational flow, forms into a spherical form and falls into acooling air flow or into a cooling or hardening solution and the outershell solution where it is gelled or solidified. This briefly describesthe formation of seamless minispheres. According to prior art the coresolution is mainly a hydrophobic solution or suspension. The outer shellsolution can be any gel forming agent but is normally gelatine- oralginate-based based but may also include polymers or other materialsthat enable controlled release. With the nozzle having two orifices(centre and outer), a hydrophobic solution can be encapsulated. Whereappropriate, it may be possible that both the core and/or shell may becomprised of a material or material composites that have been processedby a wet- or dry-extrusion mechanism, melt or otherwise fluidized priorto mixing or extrusion. Ideally, to enable drug content and releaseconsistency, it is preferred that all processes will result in fairlyuniform morphologies with a relatively smooth surface to facilitatequite even coating layers to be added in a uniform manner. With thenozzle having one or more orifices seamless minicapsules for variousapplications can be processed using minicapsule processing equipmentenabled by, but not limited to, Freund Spherex, ITAS/Lambo Globex orInotech processing equipment. As outlined above the coating process canbe carried out by any suitable means, for example, by using a perforatedpan or fluidized-baed system such as the GLATT, Vector, ACCELACOTA,Diosna, O'Hara and/or HICOATER processing equipment. Seamlessminicapsules may be manufactured using the method described in U.S. Pat.No. 5,882,680 (Freund), the entire contents of which we incorporatedherein by reference.

The invention relates to drug delivery in the colon which has beenlargely overlooked from a drug delivery perspective. Mainly havingevolved to regulate electrolyte balance and to further breakdown complexcarbohydrate structures there is a significant flow of water from thecolonic lumen into the body. In addition, the colon is home to a naturalbacterial flora to degrade complex carbohydrates to ensure effectiveexcretion, provide much needed fibre and some nutrient absorption. Witha much lower concentration of proteolytic and other enzymes populated inthe colon, it is a much more benign environment for proteins andpeptides as well as other biological entities such as carbohydrates andnucleic acids. From a drug delivery perspective, the colon presents anumber of interesting possibilities: the bacteria can be harnessed tobreak down controlled release coatings that are resistant to acidicbreakdown as well as pH differentials; the benign environment ensurethan active pharmaceuticals, including biopharmaceuticals, are lesslikely to be degraded if released locally into the colon; the almostcontinuous flow of fluids from the colonic lumen to the bloodstream maybe harnessed to carry hydrophilic entities from the intestine to thelumen. Finally, the long transit time in the colon, ranging form 10-20hours provides greater residence and potential for interaction with thecolonic mucus and epithelial cells leading to enhanced absorption intothe cells lining the colonic lumen and beyond.

A barrier to effective colonic delivery of hydrophobic and lipophilicdrugs is that the colon did not evolve to solubilize foodstuffs andother entities but rather to ensure electrolyte balance and maximisefibre breakdown and fermentation. The colon remains very porous tohydrophilic entities. By delivering hydrophobic or lipophilic drugs tothe colon in a pre-solubilised or readily soluble format and releasingsuch in the colon, the potential for absorption, local or systemic, isenhanced significantly. The present invention permits the encapsulationof pre-solubilized or readily soluble drugs in liquid or hydrolysablesemi-solids or solids into the minicapsule core and then modulation ofthe shell to include intestinal- or colon-controlled release polymers orcoating the shell with same. The result is release of optimizedformulations at specific sites along the intestinal tract for maximaltherapeutic efficacy or systemic absorption.

Likewise, delivery of formulations that are readily broken down in anaqueous environment or a bacteria rich environment has the potential,when coated with colon-specific controlled release polymers or includeentities that are degraded by bacteria have the potential to protectsusceptible entities from the gastric or intestinal environment yetensure that they are released intact in the colon where, once liberated,will be readily absorbed. Redox-sensitive, pectin, alginate, chitosan orother bacterially susceptible polymer-based matrices, coatings or othersustained release formulations, liquid, semi-solid or solid, can beencapsulated into or coated onto one- or multi-layered minicapsules.

The formulations of the present invention can exist as a multi-unit oras multi-unit minicapsules in a single-unit format. The term“multi-unit” as used herein means a plurality of discrete or aggregatedminicapsules. Single-unit formulations include, for example, tablets,hard gelatin capsules, caplets, and pills.

The methods and formulations of the present invention are intended toencompass all possible combinations of components that exhibitmodified-release and immediate-release properties. For example, aformulation and/or method of the invention can contain components thatexhibit extended-release and immediate-release properties, or bothdelayed-release and immediate-release properties, or bothextended-release and delayed-release properties, or a combination of allthree properties. For example, a multi-minicapsule or multi-minisphereformulation including both immediate-release and extended-releasecomponents can be combined in a capsule, which is then coated with anenteric coat to provide a delayed-release effect. Or, for example, adelayed- and extended-release caplet may comprise a plurality ofdiscrete extended-release particles held together with a binder in thecaplet, which is coated with an enteric coating to create a delay indissolution.

As used herein, the term “modified-release” formulation or dosage formincludes pharmaceutical preparations that achieve a desired release ofthe drug from the formulation. A modified-release formulation can bedesigned to modify the manner in which the active ingredient is exposedto the desired target. For example, a modified-release formulation canbe designed to focus the delivery of the active agent entirely in thedistal large intestine, beginning at the cecum, and continuing throughthe ascending, transverse, and descending colon, and ending in thesigmoid colon. Alternatively, for example, a modified-releasecomposition can be designed to focus the delivery of the drug in theproximal small intestine, beginning at the duodenum and ending at theileum. In still other examples, the modified-release formulations can bedesigned to begin releasing active agent in the jejunum and end theirrelease in the transverse colon. The possibilities and combinations arenumerous, and are clearly not limited to these examples.

The term “modified-release” encompasses “extended-release” and“delayed-release” formulations, as well as formulations having bothextended-release and delayed-release characteristics. An“extended-release” formulation can extend the period over which drug isreleased or targeted to the desired site. A “delayed-release”formulation can be designed to delay the release of the pharmaceuticallyactive compound for a specified period. Such formulations are referredto herein as “delayed-release” or “delayed-onset” formulations or dosageforms. Modified-release formulations of the present invention includethose that exhibit both a delayed- and extended-release, for example,formulations that only begin releasing after a fixed period of time orafter a physicochemical change has occurred, for example, then continuereleasing over an extended period.

As used herein, the term “immediate-release formulation,” is meant todescribe those formulations in which more than about 50% of activeingredient is released from the dosage form in less than about 2 hours.Such formulations are also referred to herein as “conventionalformulations.”

As used herein, the phrase “drug-release profile that is independent ofsurrounding pH” means effectively a drug composition comprising apolymeric system that is non-enteric or whose permeability andsolubility properties do not change with environmental, i.e., external,pH. Meaning, a drug composition having release characteristics such asdissolution is substantially unaffected by pH or regardless ofpH-changes in the environment. This is in comparison to a releaseprofile that is pH-dependent where the release characteristics varyaccording to the pH of the environment.

Intestinal Diseases

Gastrointestinal conditions pose a significant worldwide health problemInflammatory bowel diseases, which genus encompass a range of diseasesincluding Crohn's disease and ulcerative colitis, affect nearly 1million people in the United States each year. The two most commoninflammatory conditions of the intestine, ulcerative colitis (UC) andCrohn's disease (CD) are collectively known as inflammatory boweldisease (IBD). These conditions are diseases of the distal gut (lowersmall intestine, large intestine, and rectum) rather than the proximalgut (stomach and upper small intestine). Between the two, ulcerativecolitis primarily affects the colon, whereas Crohn's disease affects thedistal small intestine as well.

Inflammatory Bowel Disease (IBD)

Although they are distinct IBD conditions, the same drugs are commonlyused to treat both UC and CD. Drugs commonly used in their treatmentinclude steroids (e.g., budesonide and other corticosteroids, andadrenal steroids such as prednisone and hydrocortisone); cytokines suchas interleukin-10; antibiotics; immunomodulating agents such asazathioprine, 6-mercaptopurine, methotrexate, cyclosporin, andanti-tumor necrosis factor (TNF) agents such as soluble TNF receptor andantibodies raised to TNF; and also antiinflammatory agents such as zinc.The most commonly prescribed agents for IBD include sulfasalazine(salicyl-azo-sulfapyridine, or “SASP”) and related 5-aminosalicylic acid(“5-ASA”) products, including mesalazine. In refractory cases of thedisease, high doses of cyclosporin, administered intravenously, hasdemonstrated considerable and rapid efficacy.

Inflammation of the ileum (the farthest segment of the small intestine)due to Crohn's disease is known as iletis. When both the small intestineand the large intestine are involved, the condition is called Crohn'senterocolitis (or ileocolitis). Other descriptive terms may be used aswell. Diagnosis is commonly made by x-ray or colonoscopy. Treatmentincludes medications that are anti-inflammatories, immune suppressors,or antibiotics. Surgery can be necessary in severe cases. Crohn'sdisease is an area of active research around the world and new treatmentapproaches are being investigated which have promise to improve thelives of affected patients.

Gastrointestinal Graft-Versus-Host-Disease (GI-GVHD)

GI GVHD is a life-threatening condition and one of the most commoncauses for bone marrow and stem cell transplant failure. Theseprocedures are being increasingly used to treat patients with leukemiaand other cancers to eliminate residual disease and reduce thelikelihood of relapse. Unlike solid organ transplants where thepatient's body may reject the organ, in GVHD it is the donor cells thatbegin to attack the patient's body—most frequently the gut, liver andskin. Patients with mild-to-moderate GI GVHD typically develop symptomsof anorexia, nausea, vomiting and diarrhea. If left untreated, GI GVHDcan progress to ulcerations in the lining of the GI tract, and in itsmost severe form, can be fatal. Systemic immunosuppressive agents suchas prednisone, which are the current standard treatments for GI GVHD,are associated with high mortality rates due to infection and debility.Further, these drugs have not been approved for treating GI GVHD in theU.S. or European Union, but rather are used off-label as investigationaltherapies for this indication.

The current invention permits the release of cyclosporin A to the colonin a novel oral, locally acting active therapy which will reduce theneed for systemic immunosuppressive drugs such as prednisone, which iscurrently used to prevent and control GI GVHD. Drugs such as prednisonehave the unwanted and potentially dangerous side effects of weakeningthe patient's immune system leaving them susceptible to opportunisticinfections as well as substantially inhibiting the intended anti-cancereffect of bone marrow and stem cell transplants. The currentcolon-targeted immunosuppressant invention is designed to reduce theneed for systemic immunosuppressive drugs and thereby improve theoutcome of bone marrow and stem cell transplantation.

Cyclosporin is recognized, on- and off-label, as common treatments forIBD and is widely used for this purpose. However, high dose cyclosporinexhibits significant problems, including side effects to be detailedhereinafter. Additionally, both exhibit a half-life and efficacy profilethat is less than maximal, reflected in high and multiple daily doses,lower response and remission rates, and higher relapse rates, related toits site and mechanism of action and efficiency of delivery to the cellsof the distal gut. Extensive Cyclosporin absorption from the smallintestine reduces its availability at distal sites in the gut, which arethe sites of the therapeutic effect and the preferred sites of delivery,thereby necessitating high doses to be administered. Ideally, thecyclosporin should reach the distal gut (ileum and/or colon) inunchanged form, but not be absorbed into the systemic circulation as theparent compound from there. The absorption into the systemic circulationfrom proximal and/or distal sites as the parent compound results in sideeffects associated with the absorbed drug and its systemic effects.Existing oral dosage forms of cyclosporin, namely soft gelatine capsuleor oral suspension, are unsuited to controlled or ileum/colon targetedrelease. Additionally, rectally administered suppositories or enemas areinconvenient and painful.

To overcome systemic side effects and the need to administer high dosesfrequently, the current invention proposes first formulating eithercyclosporin as a solubilised formulation, encapsulating with a gellingagent to produce minicapsules. The encapsulating agent may containcontrolled release polymers that release only in the ileum or colon ormay be coated with a polymer or other coating that results in same. Theadvantages are several-fold, including: reduced systemic absorption ofthe active cyclosporin or tacrolimus which is known to result in doserelated toxicities, including nephrotoxicity, release of sufficient doseof cyclosporin in soluble form as well as a broad distribution ofcyclosporin throughout the colon. Furthermore, incorporating amucoadhesive into the encapsulating shell or coating the encapsulatingshell with a mucoadhesive may ensure that the minicapsules are incontact with the colonic mucus layer prior to releasing the activeproximal to the diseased tissue. For certain Crohn's Disease sub-groupsit may be required to enable release throughout the gastrointestinaltract, including the small intestine. Likewise for GI-GVHD, it may bebeneficial to have sustained release throughout the entiregastrointestinal tract from small intestine to colon.

Certain natural extracts, including Neem oil, aloe vera, tripala,tumeric and other essential oils, including the omega polyunsaturatedoils such as EPA, DHA, conjugated linoeic acid (CLA) and otherderivatives thereof, have potential as treatments to alleviate orprevent inflammatory bowel disease as well as other intestinaldisorders, including gastric, duodenal and intestinal ulcers.Additionally, certain plant extracts, including berry extracts such asblueberry, achi, resorcinolic/phenolic lipids, resveratrol, flavanoidsand derivatives thereof, alone or in combination, have potentialapplication in IBD and IBS and other intestinal or systems conditions.The mode of action of berry extracts, such as blueberry extract, remainsuncertain but has effect on intestinal motility, stool formation andcolonic flora. Yet other potential therapeutics include, but are notlimited to, proteins, therapeutic peptides, vaccines, antibodies orfragments thereof. Local delivery to the mucosa will overcomedegradation and ensure that a high local concentration is available toenhance therapeutic efficacy. Encapsulating any of the above, alone orin any combination, into minicapsules or minispheres and targeting therelease to areas of the intestine that are diseased provide for enhanceddisease management as well as perhaps a reduction in any potential forsystemic side effects. Furthermore, certain oils, including theessential oils, DHA and EPA are known to increase the absorption ofcertain entities throughout the gastrointestinal tract, including thecolon.

This invention is advantageous in providing methods and formulations fortreating or preventing inflammatory bowel disease. The inventionproposes delivering effective concentrations of pre-solubisedCyclosporin, Tacrolimus, Sirolimus, Hydralazine, DMOG, others orderivatives thereof, to affected areas of the gastrointestinal tract,with minimized systemic absorption of parent drug. The invention isdirected to, among other things, a pharmaceutical composition foradministration to a subject in need thereof comprising a dose of anactive pharmaceutical compound, and pharmaceutically acceptable salts,esters and pro-drugs thereof, and at least one pharmaceuticallyacceptable excipient, wherein the composition exhibits localized releaseand exhibits:

For Ulcerative Colitis and Crohn's Disease—a dissolution profile, whentested in a U.S.P. Type II apparatus (paddles) at 37.degree.C. and 50rpm, in pH 6.8 buffer for the test: Up to 4 hours: less than or equal toabout 20% drug released; 6 hours: less than or equal to about 35% drugreleased; 8 hours: less than or equal to about 50% drug released; 12hours: less than or equal to about 60% drug released; 18 hours: lessthan or equal to about 75% drug released; and 24 hours: from about 25%to about 100% drug released.

For GI-GVHD—a dissolution profile, when tested in a U.S.P. Type IIapparatus (paddles) at 37.degree.C. and 50 rpm, in pH 6.8 buffer for thetest: 1 hour: less than or equal to about 20% drug released; 4 hours:less than or equal to about 35% drug released; 6 hours: less than orequal to about 50% drug released; 12 hours: less than or equal to about60% drug released; 16 hours: less than or equal to about 75% drugreleased; and 24 hours: from about 25% to about 100% drug released.

This invention relates to formulations and methods for treating orpreventing inflammatory bowel disease. The term “inflammatory boweldisease” includes, but is not limited to, ulcerative colitis, Crohn'sdisease and GI-GVHD. Other treatable conditions would include but arenot limited to ischemic bowel diseases; necrotizing enterocolitis,intestinal lesions associated with thermal burns and leukotrieneB₄-mediated diseases; intestinal inflammations/allergies such as Coeliacdiseases, proctitis, eosinophilic gastroenteritis, mastocytosis;food-related allergic diseases which have symptomatic manifestationremote from the gastro-intestinal tract (e.g., migraine, rhinitis andeczema).

This invention relates to formulations and methods for treating orpreventing inflammatory bowel disease. The term “inflammatory boweldisease” includes, but is not limited to, ulcerative colitis, Crohn'sdisease and GI-GVHD. Other treatable conditions would include but arenot limited to ischemic bowel diseases; inflammatory bowel diseases,necrotizing enterocolitis, intestinal lesions associated with thermalburns and leukotriene B₄-mediated diseases; intestinalinflammations/allergies such as Coeliac diseases, proctitis,eosinophilic gastroenteritis, mastocytosis, Crohn's disease andulcerative colitis; food-related allergic diseases which havesymptomatic manifestation remote from the gastro-intestinal tract (e.g.,migraine, rhinitis and eczema).

As cyclosporin blocks T-cell activation, a prerequisite for HIVproliferation, it may be useful as a prophylactic for the prevention ofHIV replication. In the particular cases of HIV-1, HIV-2 and relatedretroviral strains, inhibition of T-cell mitosis would suppress thereplication of the virus, since the virus relies upon the host T-cell'sproliferative functions to replicate. The formulations in the inventionwould be useful when used alone, or in combination therapy with otherimmunosuppressants, for example, but not limited to, FK506, rapamycin,picibanil, mycophenolic acid, azathioprine, prednisolone,cyclophosphamide, brequinar, sequinivir and leflunomide as aprophylactic for the prevention of HIV replication which is rapid in thegastrointestinal tract following infection. In the particular cases ofHIV-1, HIV-2 and related retroviral strains, inhibition of T-cellmitosis would suppress the replication of the virus, since the virusrelies upon the host T-cell's proliferative functions to replicate.

The present invention provides a multiple minicapsule modified releasecomposition comprising at least one population of cyclosporin-containingminicapsules which, upon administration to a patient, exhibits a single,bimodal or multimodal release profile throughout the entiregastrointestinal tract or at pre-specified regions along thegastrointestinal tract.

The multiple minicapsule modified release composition may comprise atleast two populations of cyclosporin-containing minicapsules which, uponadministration to a patient, exhibits a bimodal or multimodal releaseprofile that results in a plasma profile within therapeuticallyeffective pharmacokinetic parameters, as appropriate.

In one case the invention provides a multiple minicapsule modifiedrelease composition comprising at least two populations of activeingredient-containing minicapsules which, upon administration to apatient, exhibits a pulsatile release profile.

The invention provides a multiple minicapsule modified releasecomposition to protect or degradative-enzyme sensitive activeingredients and to release such proximal to the intestinal epithelialcell wall or in the colon, in the lumen or proximal to the epithelialwall in the small intestine or colon.

In one case the invention provides a multiple minicapsule modifiedrelease composition whereby the active or actives are released in theileum or colon, where the active is not absorbed but may yet be locallyactive.

The pharmaceutically acceptable excipient may be chosen from carriers,fillers, extenders, binders, humectants, disintegrating agents,solution-retarding agents, absorption accelerators, wetting agents,absorbents, lubricants, stabilizers, surfactants, solubilising agents,permeability enhancers, oils, plant extracts, fish extracts, marineextracts, colouring agents, buffering agents, dispersing agents,preservatives, organic acids, and organic bases.

The invention also provides a sachet format comprising multipleminicapsule modified release composition of the present invention forease of administration to paediatrics, geriatrics or other patientpopulations with swallowing difficulties, including patients who are fedby tube.

The invention will be more clearly understood from the followingexamples.

EXAMPLES

FIG. 11 schematically illustrates—liquid-filled minicapsules withcontrolled release polymer coatings. This format comprises solubilisedcyclosporin encapsulated in a core C encapsulated using a suitablegelling agent that is further coated to permit controlled or targetedrelease along the gastrointestinal tract. The cyclosporin is in anenhanced solubilised form, as a liquid L. The open arrow represents therelease of the drug molecule M into the gastrointestinal, where it isfully soluble when released.

Example 1 Ileum- and Colon-Specific Cyclosporin A

The core formulation was prepared as follows. Cylosporine A wasdissolved in a suitable volume of ethanol. Once dissolved, the solutionwas blended with a suitable mix of Labrafil and Olive oil. The shellsolution was prepared as follows: Appropriate quantities of gelatin andsorbitol were added to water and heated to 70 degrees C. until insolution. The minicapsules were prepared using a Spherex Labo to produce2-layer minicapsules, the core of which comprises Cylosporine A in anenhanced solubilised and permeabilised formulation. In addition, thecore formulation does enable a degree of sustained release.

TABLE 1 Ileum- and Colon-specific Cyclosporin A To enable an ileum- andcolon-specific product, the minicapsules can be coated either with asustained release polymer or a combination ofcolonic-specific polymerand sustained release polymers. The following options have beendeveloped and tested: Ingredients % w/w Core Composition Cyclosporin A16.70 Labrafil M 1944 CS 18.2 Olive Oil 65 Ethanol 0.1 Shell CompositionGelatin 90.0 Sorbitol 10.0

Example 2

FIG. 1 Illustrates Cyclosporin a Release from the Minicapsules ofExample 1 Coated with 12. % and 22.5% Weight Gain Surelease®.

Example 3

Eudragit™ RS—Cyclosporin A containing minicapsules of example 1 werecoated with Eudragit™ RS with or without further coating with Eudragit™FS30D. The resulting dissolution profiles demonstrate the possibility todelay the release of the active for a number of hours and thereafter torelease it in a sustained manner. The results are displayed in FIG. 5.

Example 4

Surelease®—Cyclosporin A containing minicapsules of Example 1 werecoated with Surelease® with or without further coating with Eudragit™FS30D. The resulting dissolution profiles demonstrate the possibility todelay the release of the active for a number of hours and thereafter torelease it in a sustained manner. The results are displayed in FIG. 6.

Example 5

Surelease® and Pectin—Cyclosporin A containing minicapsules of example 1were coated with Surelease®, with or without the inclusion of high orlow molecular weight pectin in the coating solution and with or withoutfurther coating the mincapsules with the pH sensitive Eudragit™ FS30D.The resulting dissolution profile demonstrates the possibility to delaythe release of the active for a number of hours and thereafter torelease it in a sustained manner. The results are displayed in FIG. 7and FIG. 8.

Example 6

Surelease® and Alginate—Cyclosporin A containing minicapsules of example1 were coated with Surelease®, with or without the inclusion of alginatein the coating solution and with or without further coating themincapsules with the pH sensitive Eudragit™ FS30D. The resultingdissolution profile demonstrates the possibility to delay the release ofthe active for a number of hours and thereafter to release it in asustained manner. The results are displayed in FIG. 9.

Example 7

A once-daily formulation comprises minicapsules of example 1 containingcyclosporin A coated with 22% weight gain Eudragit™ RS30D to provideless than 10% release up to 6 hours, less than 30% up to 12 hours, lessthan 70% up to 18 hours and up to 100% at 24 hours. The results aredisplayed in FIG. 11.

Example 8 Ileum- and Colon-Specific Cyclosporin A

The core formulation was prepared as follows. Cylosporine A wasdissolved in a suitable volume of ethanol. Once dissolved, the solutionwas blended with a suitable mix of Labrafil and Olive oil. The shellsolution was prepared as follows: Appropriate quantities of gelatin andsorbitol were added to water and heated to 70 degrees C. until insolution. The minicapsules were prepared using a Spherex Labo to produce2-layer minicapsules, the core of which comprises Cylosporine A in anenhanced solubilised and permeabilised formulation. In addition, thecore formulation does enable a degree of sustained release.

TABLE 2 Ileum- and Colon-specific Cyclosporin A To enable an ileum- andcolon-specific product, the minicapsules can be coated either with asustained release polymer or a combination of colonic-specific polymerand sustained release polymers. Ingredients % wiw Core CompositionCyclosporin A 2.5-25  Labrafil M 1944 CS 15-35 Essential Oil 0-80 OliveOil 0-80 Ethanol 0-20 Shell Composition Gelatin 90.0 Sorbitol 10.0

Example 9 Ileum- and Colon-Specific Cyclosporin and Neem

The core formulation was prepared as follows. Cylosporine A wasdissolved in a suitable volume of ethanol. Once dissolved, the solutionwas blended with a suitable mix comprising one or more of Labrafil,Olive oil, Neem oil or other essential oils, including omega-3-rich fishoils. The shell solution was prepared as follows: Appropriate quantitiesof gelatin and sorbitol were added to water and heated to 70 degrees C.until in solution. The minicapsules were prepared using a Spherex Laboto produce 2-layer minicapsules, the core of which comprises CylosporineA in an enhanced solubilised and permeabilised formulation. In addition,the core formulation does enable a degree of sustained release.

TABLE 3 Ileum- and Colon-specific Cyclosporin and Neem To enable anileum- and colon-specific product, the minicapsules are coated eitherwith a sustained release polymer or a combination of colonic- specificpolymer and sustained release polymers. The sustained release coatingcomprises a 95:5 ratio of Eudragit ™ RS:Eudragit ™ RL. The combinationcomprises 95:5 Eudragit ™ RS:RL, further coated with Eudragit FS30D.Ingredients % w/w Core Composition Cyclosporine 0-20 Labrafil 0-35 Neem0-75 Olive Oil 0-75 Essential Oil 0-75 Ethanol 0-20 Shell CompositionGelatin 90.0 Sorbitol 10.0

Example 10—Colon-Specific, Pre-Solubilized Cyclosporin for Treatment ofIBD

Colitis was induced in mice using DSS 2.5% in drinking water. Todetermine the effectiveness of pre-solubilized cyclosporin on theprevention or treatment of DSS-induced colitis various formulations ofpre-solubilized cyclosporin minicapsules with differing release profileswere administered to mice daily. The minicapsules were prepared usingthe method described in Example 1 above. Referring to FIG. 2, in total,three Cyclosporin (0.25 mg/mouse/day) mini-formulations were used in thestudy, namely A (Immediate Release—small intestine: Uncoatedminicapsules containing cyclosporin A as per Example 1), B (IleumRelease—sustained release: Minicapsules containing cyclosporin A as perExample 1, coated with a 12.5% weight gain Eudragit™ RS30D polymercoating) and C (Colon-specific Release—sustained release: Minicapsulescontaining cyclosporin A as per Example 1, coated with a 22% weight gainEudragit™ RS30D polymer coating).

Following removal of the colon from mice on Day 7, it is observed thatwhile the DSS still exerted a shortening affect on the colon length, theadministration of all CyA formats, particularly the colon-specific CyAresulted in significantly reduced colon shortening, thereby suggestingthat CyA is exerting a protective effect against DSS-induced colitis.

A major symptom of DSS-induced colitis is weight loss. From FIG. 3 it isevident that when administered directly to the colon, 0.25 mg CyA(Capsule C) administered daily has a significant protective effectcompared mice administered with immediate (Capsule A) or ileum-release(Capsule B) CyA. This data set suggests that when administeredspecifically to the colon daily at low concentration; CyA has apronounced protective effect on DSS-induced colitis.

Referring to FIG. 4, the disease activity index (DAI) is calculated asthe sum of scores of weight loss, stool consistency and blood in feces.Normal stool=formed pellets; loose stool=pasty and semi-formed stoolwhich do not stick to the anus; diarrhoea=liquid stools that stick tothe anus. This composite scoring system clearly demonstrates that dailyadministration of 0.25 mg CyA specifically to the colon (DSS-COAT beads)produces a pronounced protective effect against the induction of colitisin DSS treated mice.

Formulations and uses based on cyclosporin A are described above.However, it will be appreciated that the invention can also be appliedto other cyclosporins including cyclosporins-B, -C, -D, -G, derivatives,prodrugs, esters and/or salts thereof as well as mixtures containingmore than one of the above.

In addition, the invention envisages the use of a cyclosporin incombination with another therapeutically or propylactically activeentity.

The composition may, for example by combined with another activepharmaceutical in a single oral dosage form.

Other immunosuppressants could be considered, either alone or incombination with cyclosporin or derivatives thereof. These include, butare not limited to, various other calcineurin inhibitors such as but notlimited to Abetimus, Deforolimus, Everolimus, Gusperimus, Pimecrolimus,Sirolimus, Tacrolimus, Temsirolimus, glucocorticosteriods; cytostaticssuch as Anakinra, Azathioprine, Leflunomide, Methotrexate, Mycophenolicacid, Thalidomide; antibodies such as the T-cell receptor directedanti-CD3 OKT3; the immunophilin receptor binder sirolimus; interferons;opioids; TNFα-binding proteins, including, but not limited to,infliximab, etanercept, adalimumab, curcumin and catechins; andMycophenolate Mofetil acid which acts as a non-competitive, selectiveand reversible inhibitor of inosine monophosphate dehydrogenase. Theabove list include derivatives thereof, including those modified toinclude a conjugated NO donor.

Certain natural extracts, including Neem oil, aloe vera, tripala,tumeric and other essential oils, including the omega polyunsaturatedoils such as EPA, DHA, conjugated linoeic acid (CLA) and otherderivatives thereof, have potential as treatments to alleviate orprevent inflammatory bowel disease as well as other intestinaldisorders, including gastric, duodenal and intestinal ulcers.Additionally, certain plant extracts, including berry extracts such asblueberry, achi, resorcinolic/phenolic lipids, resveratrol, flavanoidsand derivatives thereof, alone or in combination, have potentialapplication in IBD and IBS and other intestinal or systems conditions.The mode of action of berry extracts, such as blueberry extract, remainsuncertain but has effect on intestinal motility, stool formation andcolonic flora. Yet other potential therapeutics include, but are notlimited to, proteins, therapeutic peptides, vaccines, antibodies orfragments thereof. Local delivery to the mucosa will overcomedegradation and ensure that a high local concentration is available toenhance therapeutic efficacy. Encapsulating any of the above, alone orin any combination, into minicapsules or minispheres and targeting therelease to areas of the intestine that are diseased provide for enhanceddisease management as well as perhaps a reduction in any potential forsystemic side effects.

The invention also includes methods of treating inflammatory boweldisease comprising administering to a subject in need thereof apharmaceutical composition comprising a dose of a cyclosporin orpharmaceutically acceptable salts, esters and pro-drugs thereof,including various salts and enantiomers thereof or covalent ornon-covalent modified active or inactive entities, including nitricoxide donors (NO-donors) and at least one pharmaceutically acceptableexcipient. Such formulations are preferentially developed to ensurerelease in the ileum and/or colon.

The invention also provides methods of treating inflammatory boweldisease comprising administering to a subject in need thereof apharmaceutical composition comprising cyclosporin and a curcuminoid,such as, but not limited to, curcumin, with release of same targeted tothe ileum or colon.

The invention also includes non-covalent complexion of a cyclosporinwith a carrier such as cyclodextrins, maltodextrins, dextrins ormodifications thereof and targeting the release of such to the specificsites along the gastrointestinal tract.

One more embodiment of the present invention is the inclusion oftargeted gastrointestinal release of formulations containing live orlive attenuated organisms, including bacteria or genetically modifiedbacteria and/or live or live-attenuated viruses.

In the invention, in the development of cyclosporin-based combinationtreatments for inflammatory bowel disease, the non-cyclospoine-basedactive pharmaceutical ingredient is interchangeable, including any oneor combination of tacrolimus, sirolimus, hydralazine, DMOG, proply-and/or asparaginyl hydroylase inhibitors, EPA, DHA, natural plantextracts, natural marine extracts or other biological and activeentities, which may include siRNA constructs.

In the invention, in the development of cyclosporin-based combinationtreatments for Graft-Versus-Host Disease, the non-cyclosporine-basedactive pharmaceutical ingredient is interchangeable, including any oneor combination of tacrolimus, sirolimus, EPA, DHA, natural plantextracts, natural marine extracts or other biological and activeentities, which may include siRNA constructs.

In the invention, the immunological modulating entities, includingantigens, adjuvants, emulsions, oils, and small molecules areinterchangeable and may be utilised for the development of vaccines,oral tolerance modulators and allergen modulators, which may includesiRNA constructs.

The invention allows for the development of solid-, semi-solid orliquid-filled minicapsules comprising one or more layer and producedusing conventional seamless minicapsule processes, modified meltextrusion, non-pareil coating, non-pareil drug layering or otherprocesses that enable the production of the desired dosage form.

The result is modified release compositions that in operation deliverone or more active ingredients in a unique, bimodal or multimodalmanner. The present invention further relates to solid oral dosageforms, sachets or suppositories containing such multiple minicapsule orminisphere controlled release compositions as well as methods fordelivering one or more active ingredients to a patient in a bimodal ormultimodal manner. Furthermore, the invention permits targeted releaseof orally delivered formulations to specific regions of thegastrointestinal tract to maximize absorption, confer protection on thepayload, to optimize treatment of diseased intestinal tissue or enhanceoral bioavailability. Additionally, the invention enables one or morepharmaceutical active to be administered sequentially or concomitantlyto improve disease treatment and management and to benefit from thebody's natural circadian rhythms. The invention also permits the releaseof pharmaceutical actives into the ileum and colon for the enhancedtreatment of local intestinal diseases or to facilitate the absorptionof active pharmaceutical agents, including biopharmaceuticals such aspeptide and proteins.

The formulations may include the following therapeutics: steroids (e.g.,budesonide and other corticosteroids, and adrenal steroids such asprednisone and hydrocortisone, administered alone or in combination witha xanthine or methylxanthine compound such as theophylline); cytokinessuch as interleukin-10; antibiotics; immunomodulating agents such asazathioprine, 6-mercaptopurine, methotrexate, and anti-tumor necrosisfactor (TNF) agents such as soluble TNF receptor and antibodies raisedto TNF; and also antiinflammatory agents such as zinc are widelyprescribed. The most commonly prescribed agents for IBD includesulfasalazine (salicyl-azo-sulfapyridine, or “SASP”) and related5-aminosalicylic acid (“5-ASA”) products are commonly prescribed and dueto significant side-effects of some of these as well as the abovementioned therapies would benefit from targeted colonic delivery and insome cases, pre-formulated to enhance solubility or permeability.

The invention may also be used to deliver live organisms, includingvarious bacteria such as probiotics, to specific regions of theintestine or colon where they exert protective or therapeutic effects.Steidler et al (Science 2000; 289:1352-5) have shown that it is possibleto first develop genetically modified bacteria to produce proteins andthen to target the release of such proteins, including anti-inflammatorycytokines to regions of the gastrointestinal tract where they willoptimally exert protective or therapeutic effects. The bacteria may beformulated for storage stability and target the release of such agentsto the site of optimal action.

The invention further provides a multiple minicapsule modified releasecomposition comprising at least two populations of different activeingredient-containing minicapsules in which the two or more actives arereleased concomitantly.

Alternatively, the invention provides a multiple minicapsule modifiedrelease composition comprising at least two populations of differentactive ingredient-containing minicapsules in which the two or moreactives are released sequentially.

The invention is not limited to the embodiments herein before describedwhich may be varied in detail.

1. An oral composition comprising minicapsules or minispheres having acore comprising an active pharmaceutical selected from: a live or liveattenuated organism; a live or live-attenuated virus; or a combinationthereof.
 2. The composition of claim 1, further comprising anotheractive pharmaceutical.
 3. The composition of claim 2, wherein the otheractive pharmaceutical is cyclosporin.
 4. A composition of claim 3,wherein the cyclosporin is cyclosporin A.
 5. The composition of claim 1,wherein the active pharmaceutical is a bacteria or genetically modifiedbacteria.
 6. The composition of claim 5, wherein the bacteria orgenetically modified bacteria is a probiotic.
 7. The composition ofclaim 6, wherein the bacteria are formulated for storage stability.
 8. Acomposition according to claim 1, wherein the composition is fortargeted gastrointestinal release.
 9. The composition of claim 8,wherein the release is targeted to at least the colon or smallintestine.
 10. The composition of claim 1, wherein the composition is inthe form of solid oral dosage form, sachet or suppository.
 11. Thecomposition of claim 1, in a solid oral dosage form.
 12. The compositionof claim 1, wherein the composition comprises seamless minicapsules orseamless minispheres in which the active pharmaceutical is encapsulatedwith gelatin.
 13. The composition of claim 1, wherein the minicapsulesor minispheres have a modified release coating applied to them, themodified release coating being adapted such that the formulation permitstargeted release of the solubilised cyclosporin at least in the colon.14. The composition of claim 13 wherein the coating comprises apolymeric material selected from a methacrylate; ethylcellulose; or acomposite of methacrylate and ethylcellulose.
 15. A composition asclaimed in claim 14 wherein the polymeric material is ethylcellulose.16. A composition of claim 1 wherein the core is a hydrophobic solutionand the minicapsules further comprise a shell obtainable by gelling ashell solution which is a gel-forming agent.
 17. A composition of claim16 wherein the shell solution is gelatin-based.
 18. A composition ofclaim 1 wherein the minicapsules have the characteristics ofminicapsules obtained by utilisation of surface tensions of ahydrophobic core solution comprising the cyclosporin in a solubilisedform and a shell solution, which solutions are ejected through a nozzlehaving one orifice and subject to specific frequencies and which forminto a spherical form and fall into a cooling air flow or a cooling orhardening solution where the shell solution is gelled or solidified. 19.A composition of claim 18 wherein the shell solution is gelatin-basedand each minicapsule has applied thereto a coating comprising: apolymeric material selected from a methacrylate; ethylcellulose; or acomposite of methacrylate and ethylcellulose.
 20. A composition of claim1 comprising a hard gelatin capsule, a sprinkle, or a tablet containingthe minicapsules.
 21. An oral cyclosporin formulation comprising acyclosporin, another active entity and at least one pharmaceuticallyacceptable excipient and adapted to release cyclosporin in the ileumand/or colon, wherein the formulation is selected from: a formulationcomprising solid-, semi-solid or liquid filled seamless minicapsulescomprising one or more layers, the minicapsules having a release profileto release the cyclosporin in the ileum and/or colon; or a formulationcomprising minispheres comprising (i) a hydrophobic solution orsuspension comprising cyclosporin and (ii) gelatin in which thehydrophobic solution is encapsulated.
 22. An oral composition comprisingminicapsules having a core comprising a cyclosporin in a solubilisedform in combination with another active entity, wherein thenon-cyclosporin active entity is selected from a live or live attenuatedorganism; a live or live-attenuated virus; or a combination thereof. 23.A pharmaceutical formulation comprising cyclosporin and another activepharmaceutical ingredient, with release of the cyclosporin and anotheractive pharmaceutical ingredient targeted to the GI tract, the otheractive pharmaceutical ingredient being selected from: a live or liveattenuated organism; a live or live-attenuated virus; or a combinationthereof.
 24. The composition of claim 23, wherein the cyclosporin andsaid other active entity are comprised in minicapsules or minispheres.25. A multiple minicapsule modified release composition comprising atleast two populations of different active ingredient-containingminicapsules; wherein a first active ingredient is cyclosporin in asolubilised liquid form; and a second active ingredient is selected froma live or live attenuated organism and/or a live or live-attenuatedvirus.
 26. A method of treating or preventing HIV replication in asubject, the method comprising orally administering to the subject aneffective amount of cyclosporin in a solubilised liquid form included inan oral formulation which permits targeted release of the solubilisedcyclosporin at least in the colon.
 27. A method of inhibiting T-cellmitosis in a subject, the method comprising orally administering to thesubject an effective amount of cyclosporin in a solubilised liquid formincluded in an oral formulation which permits targeted release of thesolubilised cyclosporin at least in the colon.
 28. The method of claim27, wherein the method of inhibiting T-cell mitosis is further a methodfor suppressing HIV replication.